Marilynn M. Rosenthal - Health Care Systems And Their Patients

An International Perspective

Edited by
Marilynn M. Rosenthal
and Marcel Frenkel

First published 1992 by Westview Press, Inc.

Published 2018 by Routledge
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Copyright 1992 Taylor & Francis

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Library of Congress Cataloging-in-Publication Data
Health care systems and their patients: an international
perspective / edited by Marilynn M. Rosenthal, Marcel Frenkel
p. cm.
ISBN 0-8133-8078-2 (softcover)
1. Medical policy. 2. Medicine, State. I.
Rosenthal, Marilynn M. II. Frenkel, Marcel.
[DNLM: 1. Delivery of Health Care. 2. Health
Policy. 3. World Health. W 84.1 H4372]
RA411.H43 1992
362.1dc20
DNLM/DLC
for Library of Congress 90-12645
CIP

ISBN 13: 978-0-367-01587-9 (hbk)

To Helen Keren Rosenthal, health economist. Dedicated, energetic, and innovative, she is the new generation of young professionals facing the really tough budget problems with high standards and determined compassion.

To Anne Frenkel with thanks for her guidance and support

This book is the last of a sequence of several books on cross-national comparisons of health services systems. Health services systems all over the world are undergoing agonizing reappraisals of their costs, adequacy, and equity so that an up-to-date survey is welcome. The pace of change is so rapid that even this book will be out-of-date in a few years. With all deserved respect it should also be the last of its kind. Up to this time, including this book, they have drawn mainly on pre-existing data, official reports, and selected influential and knowledgeable informants. What this book has dared to contribute are vignettes of experiences of patients in each country studied although realizing that they are not representative of experiences in these countries. Nevertheless, what happened to these patients did happen in a particular context and is, therefore, a beginning contribution to the need for research in the decision making patterns of physicians, patients, administrators, and sources of funding. The great variety of patterns of use of hospitals, physician visits, surgical operations, and supply of resources cries out for primary research in depth which will include cultural perceptions of need, demand, and expectations, and practice customs of physicians.

This book covers 12 countries in as wide a range as the United States to People's Republic of China (mainland China), a wider range possibly than any other cross-national survey. Some might wish to analyze other national health care systems, yet if anyone wants to add another single country not yet studied simply by repeating the methodology of previous cross-national comparisons, little will be contributed analytically.

The logistics of primary research indicated for continuing cross-national research are operationally and financially daunting, but such research is feasible given enough money. The primary research methodologies are present. It is likely that the interest of collaborating colleagues in other countries would be forthcoming, given adequate funding. The major and crucial problem is enlisting interested funding sources, both public and private. What would be necessary is a Rockefeller-type research institute with long-range funding and relatively permanent staff. The lone-ranger type of researcher is no longer adequate for the advancement of cross-national research. What we know about the genuine problems of modern health services delivery systems so far is:

The authors are to be commended for undertaking the logistical problems of cross-national research even without the primary research I recommend. A glimmer of what primary research might yield is contained in the final paragraph of the chapter by Dale A. Rublee, an economist, in his "International Health Expenditure Trends: The United States Compared to Other Market-Oriented Countries":

While cross-national comparisons of health care expenditures provide some insight into how the U.S. fares compared to other market-oriented countries, they should not be used to make value judgments regarding the efficiency and effectiveness of our health care system. National health care expenditures, like other national priorities, should be determined by the cultural and financial requirements of that country and not by their comparative status.